Many badly run organisations tend towards what can be termed the “North Korean” school of management; a culture of secrecy, with as little information as possible allowed out, and a generally hostile attitude towards anyone from outside questioning the prevailing culture.
Hospitals are no exception, as we saw in the scandal at Mid Staffordshire and the activities of Jimmy Savile in Leeds, Stoke Mandeville and Broadmoor. Now we find a pattern of systematic failure at the Morecambe Bay NHS Foundation Trust, where an independent report has identified 20 “major” failures in care from 2004 to 2013 at Furness General Hospital. These “serious and shocking” incidents, which resulted in the deaths of 11 babies and one mother, were due to a “simultaneous failure of a great many systems at almost every level, from labour ward to the headquarters of national bodies”. It is indeed strongly reminiscent of events at Mid Staffs, as the Health Secretary admitted in the Commons yesterday.
The report identified a number of changes in culture and procedure that should be introduced as soon as possible across the NHS. By far the most important concern is the inexplicable behaviour of the whole network of regulators and watchdogs that cover the NHS to prevent the scandal. They are, after all, there to break through parochial barriers and expose bad practice wherever they find it.
The Care Quality Commission, the Health Ombudsman and the regional health authority were all apparently aware of what was happening at Furness, but patently did not act with the force or urgency they should have deployed. As the report concludes: “This was a disturbing catalogue of missed opportunities.”
The answer to all of this does not lie in creating yet another oversight body, but in making the ones we have work properly. For the NHS to be effective requires incentives for those medics and regulators who discharge their responsibilities properly, and penalties for those individuals who do not – loss of their job and the prospect of civil or criminal charges.
In the private sector, admittedly sometimes to a very muted degree, the discipline of the market place can serve such a purpose; in the NHS – rightly, for now, kept away from market mechanisms – more imaginative ways have to be invented to ensure that people do their jobs. It is sad to reflect that so many professional doctors, midwives and managers could put patients towards the bottom of their priorities, but that is indeed what seems to have happened. It is therefore right that the General Medical Council and Nursing and Midwifery Council are to investigate the staff involved.
All that said, the NHS remains an overwhelmingly professional and caring environment, with a strong ethic and extremely dedicated staff, who need no encouragement to do the right thing. It is they who ensure the service operates well despite the ever-increasing burdens placed upon it, and who are responsible for the high satisfaction levels reported in patient surveys. To judge by the treatment given to horror stories such as Mid Staffs and Furness in sections of the media, the NHS is “broken” and best reformed out of existence, its problems insoluble. Indeed, some newspapers seem surprised when anyone emerges alive from heath service care.
Whatever their agenda may be, and whatever anyone makes of the appalling events in Furness, the health service needs to be criticised and opened up, yes, but it does not need to be abolished or relegated to the status of a “safety net” for the very poor.Reuse content